Our Lady’s Hospice & Care Services (OLH & CS) has welcomed the Audit Reports conducted by the Health Service Executive (HSE) into its services during the period 2006 to 2015.
Chief Executive Officer of OLH & CS Audrey Houlihan, said; “Our primary and foremost concern at all times is the needs and care of our residents, patients and their families. I want to reassure all our supporters that we have taken the matters raised in the Audits very seriously and are committed to continuous and on-going improvement.
“While the majority of the Audits’ recommendations focus on historical matters during 2006 – 2015, we have worked systematically through the findings. They have demonstrated that the financial controls in place at that time were not sufficiently comprehensive. For that, the Board and Management offers an unreserved apology. Our current Management and Board of Directors have fully taken this on-board and acted immediately to enhance our financial procedures to ensure best practice.
“Our Lady’s Hospice & Care Services took decisive action and implemented a robust range of new financial management processes and policies. We worked actively with the HSE, Department of Health, Charities Regulator, and the Gardaí and a staff member was ultimately dismissed. 100% of the recommendations in the Audits have been implemented. The high priority recommendations were immediately addressed and some were complete before the report was finalised.
“We are committed to upholding good governance, transparency and the highest standards possible and we would like to thank all our friends and supporters for their trust and on-going support. We would also like to reassure our supporters that the practices referenced are historical and do not reflect the current robust procedures in place.
We are truly grateful for the support we are receiving from everybody who is associated with OLH & CS – our residents and patients, their families, our fundraising supporters, our staff and volunteers and the general public,” she said.
OLH & CS was established in 1879 and is one of Ireland’s oldest and largest Hospices. We are a €40 million organisation delivering care to people all over south Dublin. We have 200 beds, 600 staff and over 330 volunteers who are dedicated to helping our patients. Over the last five years more than €25 million has been spent on patients’ needs. This money has been used to fund vital positions that provide health care for those with chronic disease and at end-of-life, to pay for essential maintenance programmes and to fund major capital projects.
Actions taken by OLH & CS
- Procurement strategy developed
- Reviewed Procurement Policy
- Board Governance Review Q1/Q2 2016
- Financial controls review Q1 2016
- Accounts Payable standard operating procedure July 2016
- Bank and Cash standard operating procedure July 2016
- Independent investigation commissioned (disciplinary procedure) 6th June – 4th August 2016
- Employee dismissed September 2016
- New procurement policy October 2016
- Internal Audit function October 2016
- New legacy policy December 2016
- New expenses policy December 2016
- Public Fundraising Expenditure Committee established March 2017
- New fraud and corruption policy launched August 2017
- New credit card policy launched October 2017
- Director Compliance review / statement by external provider
- Roll out of new financial management software commenced
Response to the Audits’ findings
In early 2015, a HSE Audit set out to examine procurement practices. A second Audit was initiated in later 2015 to further review aspects of finances and processes. Both Audits were fully facilitated by Our Lady’s Hospice & Care Services.
Procurement Audit (2015)
This investigation was conducted following an anonymous allegation received by the Director General of the HSE. The allegation implied that there was no tender process at the time for €142,000 of training fees (the actual value of which was €119k) paid to a training provider in 2010/2012 with connections to the then-CEO.
We acknowledge that this review showed that there was room for improvement in processes and management have fully taken this on board.
The training provider was selected by the senior management as it had experience working in the sector. While the then-CEO absented herself from the procurement, OLH & CS agrees that aspects of the process and her abstention should have been recorded more clearly to show its methodologies. New practices haven been put in places since this time as the organisation has continued to grow and develop. The service received was judged to be effective and professional.
Second Audit (2016)
A central aspect of the second Audit focused on the circumstances surrounding the sale of a property in Spain that was donated to the hospice. As soon as this issue was raised with the CEO and the Board of Directors of OLH & CS, an independent external investigation was launched as we were concerned that the sale did not produce the expected benefit. The Board of Directors also reported its concerns to all the relevant authorities – the Gardaí, the Charities Regulator and the HSE and we have worked with them and co-operated fully with all their requirements. The Board of Directors had given authority to the then Head of Finance to manage the disposal of the property. Since this incident, OLH & CS has introduced a robust bequest and legacy policy with checks and balances to ensure transparency and that all actions are captured and flagged.
The matter was reported to the Gardaí. This precludes us from commenting on this matter further, except to confirm that the staff member involved was dismissed by Our Lady’s Hospice & Care Services.
A property near South Circular Road in Dublin was bequeathed to us in 1997 on condition that the owner’s relative would remain there for their lifetime. We have legal confirmation that Our Lady’s Hospice & Care Services is the sole beneficiary of the property and sole owner upon the resident’s death and have informed the HSE Audit team of these details.
Following a period when the relative was in an acute hospital in Dublin, the hospital requested we meet the cost of repairing the house (which was then uninhabitable) so the relative could return home. We complied as it would be against our values and ethos to allow a vulnerable older person to live in unsanitary conditions and we supported the aim to have the patient return to independent living. We are pleased to note that the relative has continued to do so since these works in 2006/7. In addition, the repairs have also preserved the future value of the property for OLH & CS.
OLH & CS’s staff and volunteers care for patients, residents and families at a most difficult time in their lives. In the past, fundraising money was used on a small number of occasions e.g. Christmas to support small gestures of gratitude and goodwill for the outstanding care provided, such as a token of gratitude after large fundraising events for a wider cohort of volunteers. We have 600 staff and over 330 unpaid volunteers, who do wonderful work above and beyond the call of duty and very occasionally entertainment was provided as a small recognition of their dedication.
A ‘staff mission’ account notes spending on initiatives that celebrate and recognise staff achievements such as long service awards and Mission Heroes awards (for those going over and above their role), which cost, in total. under €2,000 annually.
The HSE Audit also examined credit card expenditure, and all costs incurred for operational usage and for staff and volunteer support. Over the six year reference period 2010 – 2015, under €5,000 per annum was related to direct operational costs. For example, an annual pharmacy license (€11,135 over the period), organisational vehicles and TV licenses. Of the remainder, under €2,000 per annum was related to volunteer support and business hospitality and was all vouched.
OLH & CS Board of Directors has 11 members who provide their services and expertise for free and do not receive any payment or expenses. Over the last 10 years OLH & CS has on occasion provided dinners for the Board of Directors averaging €300 per annum in total.
In 2016, our Board of Directors commissioned an independent governance review to build upon our governance framework. All its recommendations were acted upon including the establishment of a nominations committee to oversee Board appointments and a review of information flow to clinical and corporate governance committees to ensure adequate director awareness of key service matters. They also complete an annual Directors’ Compliance Statement as part of Board responsibilities under the Companies Act. In addition to this, our Board completes an annual compliance statement as part of our funding arrangements with the HSE.
Background information on Our Lady’s Hospice & Care Services (OLH & CS)
Established in 1879 by the Congregation of the Religious Sisters of Charity, Our Lady’s Hospice & Care Services (OLH & CS) is a 200 bed facility that provides specialist care for those with a wide range of needs from rehabilitation to end-of-life care. Just over 600 staff and 330 volunteers work with residents, patients and their families at a most difficult time in their lives.
This person-centred care is provided both on-site in Harold’s Cross Hospice and Blackrock Hospice as well as in people’s own homes across south Dublin. There is also a state-of-the-art Education & Research facility, which provides courses, seminars and workshops.
In 2017, we provided specialist care to over 4,290 patients and residents across all our services, reflecting a 9% increase in patient numbers from 2016. We also undertook over 10,700 specialist palliative homecare with each one of our 25 specialist palliative care team making an average of 417 visits per year. With the volume of those aged over 65 in Ireland set to almost triple in the next 30 years, the Hospice needs to provide even more specialist facilities and services to ensure the highest quality of life for our patients and their families.
Specialist palliative care: palliative care is provided in both on both sites and through our 25 specialist community palliative care nurses, who make over 12,300 homecare visits per year.
Care of the older person: Anna Gaynor House is our long-stay facility in Harold’s Cross. Our residents include older people with chronic illness as well as younger residents with neurological conditions. The Community Reablement Unit (CRU), also based in Harold’s Cross, is a team working with over 65s who are referred for in-patient rehabilitation, which enables them to remain living independently in their own homes.
Rheumatic and Musculoskeletal Disease Unit: Our consultant-led team in Harold’s Cross brings together experts from a range of disciplines to treat, support and care for those living with arthritis, rheumatic disease, fibromyalgia and other bone and muscle diseases. The goal is to empower patients and improve or maintain their quality of life.